Pearls of ManagementUSE IDEAL BODY WEIGHT---- train yourself to do it not when

only asked!!!!!!Get HELP: Anaes, ID, specialist oncallIts a judgement call that needs to be made AT THAT TIMEnot sometime today/tomorrowAt every review: commit to the following:peripheral warmth,CRT,pulse volume( not just rate) and bp,lab ix,presence/reduction/ absence of warning signs, intake output charting.

---------- MAKE A HOLISTIC DECISION!!!!!!!--------------

Pearls of Management- contsTry and use the guidelines as a guide alone

Choice of fluidsNo advantage of using colloids or crystalloidsColloids better at restoring Bp urgently , reducing

HCT faster ( best data with voluven)

Most have their own limitationsCrystalloids0.9% normal salineBest for resuscitation intiallyNormal anion gap hyperchloraemic acidosis

Ringers lactateGood alternative if the cl is increasing trend--caution in liver failure and metformin (stop).

Choice of fluidsColloidsDextran based, gelafusinBinds to vonWF as well as factor 8 and impairscoagulationAllergic reactionGelafusin has the highest allergic reaction butleast impairment in coagulationCan be used if there is elevation in HCT despitenormal saline boluses( stable or unstable pt)

Sometimes it just does not make

sense..Pt seems to be improving and there is acidosis.Could be due to the normal saline infusion given causesnormal anion gap acidosisSometimes parameters are improving but Bp is lowis it sepsis wide pulse pressure, bounding pulse